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“Who are you calling rural?”: An Analysis of Classification Codes Evaluating Disadvantage in Rural Regions and their Correlation in an Appalachian Kentucky Cohort
Lauren Bojarski, Cassity R. High, Christopher J. McLouth, Erin L. Abner, Rada Choate, Elif Pinar Coskun, Elizabeth K. Rhodus, Lauren N. Whitehurst et al.. Alzheimer s & Dementia, 2025-12-01
Topic: Risk, prevention and care in population studies
Proportions defined as living in a rural or disadvantaged area varied by classification, ranging from 13% to 27% of the cohort. Less than 1% of the total cohort met all 5 classifications, suggesting a significant lack of overlap in these constructs. HRSA Rural and MUA/HPSA classifications overlapped in 19% of the cohort (p <0.0001). These HRSA classifications were highly associated with ADI State decile and National percentile scores (p <0.0001), but not with RUCC codes (p = 0.05). ADI State decile and National percentile codes were highly associated with one another (p <0.0001), but not with RUCC codes (p = 0.48 & 0.59 respectively). These data demonstrate significant overlap in HRSA and ADI classification systems, but not between these classifications and RUCC codes. We propose that the meaning of rurality remains broad and defined by multiple aspects, and care should be taken to not conflate these different classification systems as each may serve a unique purpose, several may be related to each other, but none are fully interchangeable.
Key findings
- Proportions defined as living in a rural or disadvantaged area varied by classification, ranging from 13% to 27% of the cohort.
- Less than 1% of the total cohort met all 5 classifications, suggesting a significant lack of overlap in these constructs.
- HRSA Rural and MUA/HPSA classifications overlapped in 19% of the cohort (p <0.0001).
- These HRSA classifications were highly associated with ADI State decile and National percentile scores (p <0.0001), but not with RUCC codes (p = 0.05).
- ADI State decile and National percentile codes were highly associated with one another (p <0.0001), but not with RUCC codes (p = 0.48 & 0.59 respectively).
Why it matters
This study compared different ways of classifying whether people live in rural or disadvantaged areas and found the classifications often did not overlap. It is about how researchers define rurality and disadvantage, not about treating, curing, or preventing Alzheimer's disease.
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Study details
- Study designcross-sectional
- Evidence strengthModerate
How this study scored 38/100
Published in a peer-reviewed journal, and it is a snapshot of people at one point in time. Scored zero for sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 4 / 12 | A snapshot of people at one point in time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Gregory A. Jicha: h-index 96 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Kentucky: institution h-index 824 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41434895) |
| Free to read | 2 / 2 | Free to read |
| Total | 38 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1002/alz70860_106278
- PubMed: 41434895
- Original source →
- Free full text: Alzheimer s & Dementia →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Bojarski, L., High, C. R., McLouth, C. J., Abner, E. L., Choate, R., Coskun, E. P., et al. (2025). “Who are you calling rural?”: An Analysis of Classification Codes Evaluating Disadvantage in Rural Regions and their Correlation in an Appalachian Kentucky Cohort. Alzheimer s & Dementia. https://doi.org/10.1002/alz70860_106278
Vancouver
Bojarski L, High CR, McLouth CJ, Abner EL, Choate R, Coskun EP, et al. “Who are you calling rural?”: An Analysis of Classification Codes Evaluating Disadvantage in Rural Regions and their Correlation in an Appalachian Kentucky Cohort. Alzheimer s & Dementia. 2025. doi:10.1002/alz70860_106278. PMID: 41434895.
BibTeX
@article{bojarski2025-41434895,
author = {Bojarski, Lauren and High, Cassity R. and McLouth, Christopher J. and Abner, Erin L. and Choate, Rada and Coskun, Elif Pinar and Rhodus, Elizabeth K. and Whitehurst, Lauren N. and others},
title = {{“Who are you calling rural?”: An Analysis of Classification Codes Evaluating Disadvantage in Rural Regions and their Correlation in an Appalachian Kentucky Cohort}},
journal = {Alzheimer s \& Dementia},
year = {2025},
doi = {10.1002/alz70860_106278},
pmid = {41434895},
url = {https://doi.org/10.1002/alz70860_106278}
}
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